A non-government entity
Anthem Veteran (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Veteran (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Veteran (PPO) in 2026, please refer to our full plan details page.
Anthem Veteran (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Veteran (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Veteran (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Anthem Veteran (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $70.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Anthem Veteran (PPO).
Additional Benefits
The Anthem Veteran (PPO) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care, telehealth, preventive care, and home health services. For inpatient hospital stays, members pay a daily copay for the first few days with no coinsurance, while emergency room care is covered with a flat $115 copay. Specialist visits and physical therapy are also accessible with low copayments and no coinsurance. In addition to medical care, the plan provides valuable routine benefits including no copays for annual vision and hearing exams, alongside allowances for eyewear and hearing aids. Dental services are covered up to a $2,000 annual limit, featuring no copays for preventive care and a 25% coinsurance for comprehensive procedures. Members also enjoy extra benefits like a $65 quarterly over-the-counter allowance and up to 60 one-way transportation trips per year at no cost.
Inpatient Hospital See details
Anthem Veteran (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $360 for days 1 through 5 of an acute stay and $295 for days 1 through 6 of a psychiatric stay, with no copays for additional days. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Veteran (PPO) outpatient services are covered with no coinsurance, offering no copay for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services require a copay of $0 to $280 (including $280 per stay for observation services), and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem Veteran (PPO) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Veteran (PPO) covers ambulance services with a $340 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Anthem Veteran (PPO) covers emergency services with a $115 copay and urgently needed services with a $25 copay, featuring no coinsurance for either service. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Anthem Veteran (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay and no coinsurance, mental health services have a $40 copay and no coinsurance, and chiropractic care is not covered.
Preventive Services See details
Anthem Veteran (PPO) covers preventive services with no copayments and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered; however, health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Anthem Veteran (PPO) covers hearing services with no coinsurance, featuring a $45 copay for Medicare-covered exams and no copay for routine exams, fittings, and hearing aids. This benefit is partially covered, as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, though other prescription aids up to $2,000 annually and OTC hearing aids up to $300 annually are covered with no copay.
Vision Services See details
Anthem Veteran (PPO) provides partially covered vision services with no deductibles and no coinsurance, featuring no copay for one annual routine eye exam (up to a $69 limit) and covered eyewear (up to a $200 limit). Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Veteran (PPO) up to an annual maximum of $2,000 for both in-network and out-of-network care, excluding maxillofacial prosthetics, implant services, and orthodontics. Diagnostic and preventive care is provided with no copay and no coinsurance, while covered comprehensive dental procedures require no copay and a 25% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Veteran (PPO) with no copay, requiring prior authorization and step therapy from Part B to Part D. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Veteran (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Veteran (PPO) with no copays, though coinsurance and prior authorization may apply. Durable medical equipment has a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Veteran (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic tests and lab services feature no coinsurance and copays ranging from no copay up to $100, while radiological services require a minimum $50 copay for diagnostic imaging, a $90 copay for X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Veteran (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Veteran (PPO) plan, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Anthem Veteran (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Veteran (PPO) partially covers other services with no copay and no coinsurance, which includes Medicare Community Resource Support, chronic illness meal benefits, and a $65 quarterly allowance for over-the-counter items. Acupuncture is not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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